The Care Inspectorate is rolling out new ways of inspecting the quality of care and support, to help provide public assurance and support improvement in care services.
It is starting by changing the way it inspects care homes for older people. These new inspections will reflect the new Health and Social Care Standards, published in 2017, and which set out what people should experience from care and support in Scotland. Since then, there has been consultation with people who provide and commission care home services, and people who experience care, about a new quality framework to use on inspections.
The Care Inspectorate will be starting its new approach in care homes for older people, from July 2018, and it has contacted relevant care service providers and chief officers of local partnership about these changes.
The new approach will still feel familiar to people who have experienced recent inspections over recent years. However, the new approach better reflects the Scottish Government’s new Health and Social Care Standards and provides much more transparency about the Care Inspectorate’s expectations of quality.
The new Quality Framework for Care Homes for Older People sets out some key questions about the difference a care home is making to people’s wellbeing and the quality of the elements that contribute to that. Care services can use the framework to evaluate their own performance and the framework will also be used on inspections and in improvement advisory work.
The Care Inspectorate involved people who experience and provide care and support. It tested versions of the framework in about 60 care homes for older people, between November 2017 and May 2018. These tests included listening to people experiencing care, their carers, and care providers. The tests and people’s experiences of them helped to refine the framework and the way it will be used.
How is the framework structured?
The framework is structured around five key questions:
- How well do we support people’s wellbeing?
- How good is our leadership?
- How good is our staff team?
- How good is our setting?
- How well is our care and support planned?
Future inspections will evaluate (grade) these using the six-point scale. Under each key question, there are three or four quality indicators, covering specific areas of care practice. Each quality indicator has illustrations of what ‘very good’ quality would look like, and what ‘weak’ quality would look like. These illustrations are drawn from the Health and Social Care Standards but are not checklists or definitive descriptions. They are designed to help people understand the quality level the Care Inspectorate will be looking for.
Each quality indicator includes a scrutiny and improvement toolbox. This includes examples of how the Care Inspectorate, or care providers, might evidence the quality of provision. It also contains links to practice documents that will help care services in their own improvement journey.
How will the quality framework be used on inspections?
The framework replaces the previous practice of inspecting against themes and statements. Inspectors will look at a selection of the quality indicators. They will not look at all quality indicators on each inspection but will select a number of indicators from a number of key questions.
How many they look at will depend on the type of inspection, the quality of the service, the intelligence the organisation holds about the service and risk factors that it may identify. The Care Inspectorate will always look at the quality indicators about people’s wellbeing and care planning.
What about evaluations (grades)?
Inspectors will provide a specific evaluation (grade) for each quality indicator that is inspected and show this in the inspection report. The evaluations for each set of quality indicators will inform an overall evaluation for the key question that the indicators sit under. Where inspectors decide to inspect just one of the quality indicators under a key question, the evaluation given to the indicator will automatically be the same for the key question. Where more than one quality indicator per key question is inspected, the overall evaluation for the key question will be the lower of the quality indicators for that specific key question. This is because if the inspectors evaluates a key question as being, for example, ‘very good’, the Care Inspectorate expects that all the indicators inspected under that particular key question to be ‘very good’.
What might this look like?
If the inspector evaluates just one quality indicator, 2.2, as ‘very good’, the evaluation for key question 2 will be ‘very good’. If quality indicators 2.1, 2.2, and 2.4, are found to be ‘good’, ‘adequate’, and ‘good’ respectively, the overall evaluation for that key question will be ‘adequate’.
What happens next?
The new approach starts in care homes for older people from 30 July 2018. The Care Inspectorate is currently developing specific quality frameworks for other care settings, and will be working in partnership with the sector and people who experience care and support to do this in the months ahead.
Where can I find out more?
The Care Inspectorate has written to care service providers and chief officers of local partnership to provide an update on the new and developing inspection approaches.